Comparison of COVID-19 Innovation Between the United States, Europe and China

1. Background

We sought to determine which region, People’s Republic of China (China), the United States of America (US) or Europe (as defined by the World Health Organization) (WHO, 2020) has been more “innovative” during the COVID-19 epidemic over time, as measured by searching the full content of peer-reviewed scholarly work on COVID-19 produced from January to November 2020.

2. Methodology

We analyzed the iSearch COVID-19 platform (NIH’s comprehensive, expert-curated source for publications and preprints related to either COVID-19 or the novel coronavirus SARS-CoV-2) for research articles in several key categories and subcategories from January to November (NIH, 2020). All COVID-related research articles were sorted by country of origin at 4 time points (the last date of March, June, September and November). US, European and Chinese (including Hong Kong and Macau) institutions were separated while all remaining countries were designated as “Other.” These research articles were further filtered by publication in the 16 top medical journals worldwide by highest H-index, excluding non-medical journals (Nature, Science, Cell, Lancet, PNAS, JAMA, Nature Medicine, Clinical Infectious Disease, Clinical Virology, Medical Virology, European Respiratory Journal, Lancet Infectious Disease, Lancet Respiratory Medicine, Critical Care, Infection, Head and Neck) (SJR, 2020).

Research articles were divided based on 3 clinically relevant categories: Therapeutics (Remdesivir, Methylprednisolone), nonTherapeutics (Swabs, Masks) and Biological Mechanisms of Action (Oxygen, ACE-2, Immunoglobulins, D-Dimer). Nonresearch articles, such as Reviews, Editorials, Personal Narrative, Case Reports, News and Practice Guidelines were excluded from this analysis.

A full list of institutions of primary author affiliations for each article was imported into Google Sheets, and the number of articles indexed to each primary institution was recorded. Each institution was categorized by country of origin through ezGeocoding (https://geocode.ez34.net/), and total number of publications per country was calculated. Linear regression and normalization was performed in Microsoft Excel (Version 2020). Population data was aggregated from the World Bank (World Bank, 2020). Number of articles per citizen calculation was a calculated average from the 4 timepoints during the pandemic.

3. Results & Conclusions

The total number of articles in the Top T16 journals until the end of March was 1,065, June was 5,725, September was 9,100 and November was 10,011. The number of articles published by Chinese researchers were initially 69% greater than the United States and 45% greater than Europe; they were narrowly overtaken in June (19%) by the United States, a deficit which expanded by September (118%) when Europe also overtook China (52%) (Figure 1). By November, the US had the greatest number of research articles, followed by Europe and then China. Number of research articles closely follow each nation’s respective patient loads (r2 = 0.93, China; r2 = 0.89, US; r2 = 0.79, Europe) (Figure 2). High research output correlated with China’s first quarter caseload peak, followed by the second and third quarter peaks in the United States and Europe. (Institute for Health Metrics, 2020). After normalization of total articles over the past 11 months with population, the US held a greater average research output per citizen (7.6 articles per million citizens), followed by Europe (3.76 articles per million citizens) and China (0.96 articles per million citizens) (Figure 3).

Research articles focusing on therapeutics, specifically the two only clinically proven medications for COVID-19, Methylprednisolone and Remdesivir, remained dominated by Chinese authors in T16 Journals worldwide during the first half of the pandemic, after which US authors gained the lead (Figure 4a). In non-therapeutic technologies, Chinese researchers published more articles during the early stages of the pandemic. European authors however overtook both the US and China by June. (Figure 4b). In basic science mechanism of action categories, Chinese investigators published more research articles during the period of this study, until November. In specific areas of research, ACE-2 and Immunoglobulins, US authors had more publications than Chinese or European counterparts by June and widened their lead by September (Figure 4c).

Our study has limitations as the journals included in our analysis were all English-language; we expect COVID-19 publications in native Chinese and European journals, however as they were not PubMed based, they could not be analyzed. Other research vehicles, including patents, drug discovery and clinical trials, were not included in this study and could be useful in comparing innovation between countries.

Our study shows a clear pattern of all three major world players accelerating COVID research output coinciding with periods when their respective caseloads are high. The United States showed the greatest research output per citizen overall, followed by Europe and then China. Each nation has specific areas of research where they have the strongest overall output, non-Therapeutics for European authors, Therapeutics for US and Biological Mechanisms of Action for Chinese authors. Despite China’s new entrance into the global research landscape, they have taken a competitive position in COVID research during the pandemic and lead innovation in key clinical categories.

4. References

[1] Countries. (2020, December 6). https://www.euro.who.int/ en/countries

[2] NIH Office of Portfolio Analysis. https://icite.od.nih.gov/ covid19/search/. Retrieved on October 1, 2020 from https://icite. od.nih.gov/covid19/search/

[3] SJR : Scientific journal rankings. (n.d.). Scimago Journal & Country Rank. https://www.scimagojr.com/journalrank. php?order=sjr&ord=desc

[4] Institute for Health Metrics and Evaluation. https://covid19. healthdata.org/. Retrieved on October 1, 2020 from https:// covid19.healthdata.org/. [5] WDI - Home. (n.d.). Retrieved from https://datatopics. worldbank.org/world-development-indicators/